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GI > Intestinal Failure and other Small Bowel Problems > Flashcards

Intestinal Failure and other Small Bowel Problems Flashcards

1
Q

What is intestinal failure?

A

Where the gut is no longer able to supply the hydration and nutritional needs of the body

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2
Q

What is acute intestinal failure?

A 
Short term (2 weeks) 
Type I and II intestinal failure
e.g. mucositis post chemo
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3
Q

What is chronic intestinal failure?

A

Long term
Type III intestinal failure
e.g. short gut syndrome

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4
Q

What is Type I intestinal failure?

A

Self limiting, short term

Post operative or paralytic ileus

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5
Q

What is Type II intestinal failure?

A

Prolonged
Accosted with sepsis or metabolic complications
Often related to abdo surgery with complications

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6
Q

What is Type III intestinal failure?

A

Long term but stable

Home parenteral neutron often indicated

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7
Q

How is Type I intestinal failure managed?

A

Fluid replacement, correct electrolytes
Parenteral nutrition if unable tolerate food/fluids after a week
Acid suppression: PPIs
Octreotide
Mg preservation (a hydroxycholecalciferol)
Allow some enteral feeding if poss

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8
Q

Which veins are generally used for parenteral nutrition?

A

Large veins, especially in the neck

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9
Q

What are the complications of parenteral nutrition?

A 
Pneumothorax 
Arterial puncture 
Misplacement 
Sepsis 
SVC thrombosis 
Line fracture/leakage/migration 
Metabolic bone disease 
Nutrient toxicity/insufficiency 
Liver disease 
Metabolic disturbance 
Psycho-social 
Inappropriate usage
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10
Q

What are the feeding options for Type II intestinal failure?

A

Parenteral +/- some enteral feeding

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11
Q

What are the two current options for management of Type III intestinal failure?

A

Home parenteral nutrition

Intestinal transplantation

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12
Q

What conditions could result in Type III intestinal failure and require HPN?

A 
Short gut syndrome 
Crohn's disease 
Neoplasia (not an indication in the UK) 
Vascular 
Mechanical 
Radiation enteritis 
Dysmotility
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13
Q

What is short bowel syndrome?

A

A bowel of less than 200cm

Insufficient length to meet nutritional needs without artificial nutrimental support

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14
Q

At what length must the small bowel be in order to indicated HPN?

A

Less than 50cm + all of colon

Less than 100cm + no colon

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15
Q

What are the main indications for small bowel transplantation?

A

Loss of venous access for HPN or liver disease

usually combined with liver transplant

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16
Q

Where is the blood supply for the small bowel derived from?

A

Superior mesenteric artery

17
Q

What are the causes of small bowel ischaemia?

A

Mesenteric arterial occlusion =
Mesenteric artery atherosclerosis
Thromboembolism from heart

Non occlusive perfusion insufficiency = 
Shock 
Strangulation obstructing venous return 
Drugs 
Hyperviscosity
18
Q

How is acute ischaemia of the small bowel classified?

A

By degree of infarction caused (mucosal, mural or transmural)
The longer the period of hypoxia, the more severe the ischameia

19
Q

What are the complications of small bowel ischaemia?

A

Resolution
Fibrosis, stricture, chronic ischaemia, “mesenteric angina and obstruction
Gangrene, perforation, peritonitis, sepsis and death

20
Q

What causes Meckel’s Diverticulum?

A

Incomplete regression of the vitello-intestinal duct

21
Q

What are the complications of Meckel’s Diverticulum?

A

Often asymptomatic

May cause bleeding, perforation or diverticulitis which mimics appendicitis

22
Q

Which types of tumours are more common in the small bowel?

A

Primary are rare

Metastases from ovary, colon and stomach are more common

23
Q

What are some primary tumours of the small bowel?

A

Lymphomas
Carcinoid tumours
Carcinomas

24
Q

What types of lymphoma occur in the small bowel, and what is their treatment?

A

All non-Hodgkins in type
Maltomas (b-cell) derived
Enteropathy associated with T-cell lymphomas (associated with coeliacs)

Surgery and chemotherapy

25
Q

What is the most common site for carcinoid tumours of the small bowel?

A

Appendix

26
Q

What are carcinoid tumour of the small bowel like?

A

Small, yellow, slow growing
Locally invasive
Produce hormone like substances

27
Q

What are the complications of carcinoid tumours of the small bowel?

A

Can cause intussusception, obstruction

If metastases to the liver, a carcinoid syndrome occurs, producing flushing and diarrhoea

28
Q

What is the pathology of acute appendicitis?

A

Aute inflammation (neutrophils), which MUST involve the muscle coat
Mucosal ulceration
Serosal congestion, exudate
Pus in lumen

29
Q

What are the complications of appendicitis?

A 
Peritonitis
Rupture 
Abscess
Fistula 
Sepsis and liver abscess
30
Q

What is coeliac disease?

A

An abnormal reaction to gluten which damaged enterocytes and reduces absorptive capacity

31
Q

What does coeliac disease have a strong association with?

A

HLA-B8
Dermatitis herpetiformis
Childhood diabetes

32
Q

What is the aetiology of coeliac disease?

A

Glaidin (component of gluten) is the suspected toxin
Tissue injury may be a bystander effect of abnormal autoimmune reaction to Glaidin
Mediated by T-cell lymphocytes which exist within the small intestinal epithelium

33
Q

What does the surface epithelium of the small bowel look like in coeliac disease?

A

Loss of villous structures due to loss of enterocytes from IEL mediated damage

34
Q

What is the result of the loss of villi in coeliac disease?

A

Loss of surface area
Reduction in absorption
Flat duodenal muscle

35
Q

What are the metabolic effects of coeliac disease?

A

Malabsorption of fats, sugars, amino acids, water and electrolytes
Steatorrhoea
Reduced intestinal hormone production, so reduced pancreatic secretion and bile flow, causing gallstones

36
Q

What are the effects of malabsorption in coeliac disease?

A 
Unexplained weight loss
Anaemia (Fe, Vit B12, Folate) 
Abdominal bloating 
Failure to thrive 
Vitamin deficiencies
37
Q

Other than malabsorption, what are the complications of coeliac disease?

A

T cell lymphomas of GI tract
Increased rose of small bowel carcinoma
Galls stones
Ulcerative-jejenoilleitis

GI (24 decks)

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